Provider Demographics
NPI:1609975440
Name:LINDEMANN, JASON R (PT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:R
Last Name:LINDEMANN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 D. LYONS RD.
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459
Mailing Address - Country:US
Mailing Address - Phone:937-434-0509
Mailing Address - Fax:937-434-1825
Practice Address - Street 1:1145 LYONS RD # D
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-1875
Practice Address - Country:US
Practice Address - Phone:937-434-0509
Practice Address - Fax:937-434-1825
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PT-008779225100000X
OHPT8779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000008368OtherANTHEM
HI365572300OtherTRICARE
OH310979866026OtherCARESOURCE
OH0542283Medicaid
OH31097986600OtherBWC
OH365572300OtherUS DEPT LABOR
OH125384133OtherTRICARE
OH125384133OtherTRICARE
HI365572300OtherTRICARE
4035831Medicare UPIN
OH0542283Medicaid
4035834Medicare PIN